Table 3.
Response to biological agents (bDMARDs) in obese/overweight patients with rheumatoid arthritis.
| Author (Reference) | Number of Subjects | Sex Ratio M/F (%) | Disease Duration (Years) | Obese/Overweight Subjects (%) | bDMARDs | Outcome | Main Results |
|---|---|---|---|---|---|---|---|
| Heimans [55] | 508 | 32/68 | 0.4 | obese and overweight: 57.4 | csDMARDs combination or MTX + IFX | DAS≤ 2.4 at one year | RR DAS≤ 2.4 at one year in obese /overweight patients: 2.2 [0.99–4.92] |
| Klaasen [56] | 89 | 23/77 | 7 | obese: 16.8 | IFX [3 mg/kg) | ∆DAS28 week 16 | Negative relationship between BMI and ∆DAS28 or remission |
| Smolen [57] | 761 | 17/83 | 6.9 | overweight: 35.2 obese: 16.7 |
ETA (50 mg/week) | remission (according to DAS28, CDAI, SDAI) week 36 | Negative relationship between BMI and remission |
| Gremese [58] | 641 | 19/81 | 8.4 | overweight: 32.3 obese: 10.3 |
IFX(3mg/kg), ETA (50 mg/week) or ADA (40 mg eow) | remission (DAS28) at one year | % remission in obese/overweight patients < normal BMI |
| Ottaviani [59] | 76 | 17/83 | 8 | overweight: 38.2 obese: 28.9 |
IFX (3 mg/kg) | ∆DAS28 ≥ 1.2 at 6 months | Fewer responders in overweight/obese patients compared to normal BMI |
| Iannone [60] | 292 | 15/85 | 12 | overweight: 37.3 obese: 22.6 |
All bDMARDs at the second line of treatment | drug survival at one year | Less drug persistence in obese patients versus normal weight |
| McCulley [61] | 23,669 | 87/13 | NA | overweight: 36.6 obese: 40.1 |
All csDMARDs and subcutaneous injectable TNFi | time to treatment discontinuation | Severe obesity not associated with treatment discontinuation compared to overweight BMI for all except prednisone. Low BMI was associated with TNFi discontinuation |
| Pers [62] | 222 | 17.6/82.4 | 14 | overweight: 26 obese: 15.5 |
TCZ IV (8 mg/kg) | EULAR response at month 6 | Similar response according to BMI |
| Gardette [63] | 115 | 84.3/15.7 | 11 | overweight: 32 obese: 22 |
TCZ IV (8 mg/kg) | ∆DAS28 ≥ 1.2 at month 6 | No effect of BMI on TCZ response |
| Ottaviani [64] | 114 | 81.5/18.5 | 9.6 | overweight: 35.9 obese: 30 |
RTX IV (1 g × 2 days 1 and 15) | ∆DAS28 ≥ 1.2 at month 6 | No effect of BMI on RTX response |
| Gardette [65] | 141 | 82.3/17.7 | 12.5 | overweight: 27 obese: 27.6 |
ABA IV (500 mg < 60 kg; 750 mg 60–100 kg; 1000 mg > 100 kg) | ∆DAS28 ≥ 1.2 at month 6 | No effect of BMI on ABA response |
| D’Agostino (ACQUIRE trial) [66] | 1456 | 82.5/17.5 | 7.6 | overweight: 34 obese: 30 |
ABA IV or SC | Remission (DAS28 < 2.6) at month 6 | Rate of remission similar across BMI groups |
| Mariette (ACTION study) [67] | 643 | 73.8/26.2 | 7.2 | overweight: 35 obese: 24 |
ABA IV (500 mg < 60 kg; 750 mg 60–100 kg; 1000 mg > 100 kg) | Drug retention at 6 months | Retention rates similar across BMI groups |
| Di Carlo [68] | 130 | 83.8/16.2 | 11.2 | NA | ABA SC or IV | DAS28 remission or Boolean criteria for remission | No effect of BMI on ABA response |
| Ianone (PANABA registry) [69] | 2015 | 80.6/19.4 | 10.2 | obese: 18.9 | ABA IV (500 mg < 60 kg 750 mg 60–100 kg; 1000 mg > 100 kg) | Drug retention of ABA | No difference in ABA retention between obese and non obese patients |
(TNF inhibitor, IL-6 inhibitor, co-stimulatory inhibitor and B-cell depletion agent) in rheumatoid arthritis according to body weight or body mass index (M: male; F: female; BMI: body mass index; bDMARD: biological disease-modifying antirheumatic drug; csDMARD: conventional synthetic disease modifying antirheumatic drug; IFX: infliximab; ETA: etanercept; ADA: adalimumab; TCZ: tocilizumab; ABA: abatacept; RTX: rituximab; MTX: methotrexate; RA: rheumatoid arthritis; DAS28: disease activity score 28 joints; SDAI: simplified disease activity score; CDAI: clinical disease activity index; RR: relative risk; eow: every other week; IV: intravenous; SC: subcutaneous; NA: not available).